From preliminary evidence, exposure to the 9/11 World Trade Center (WTC) disaster increases risk of cardiovascular diseases (CVD). The WTC-Heart cohort study, established in 2011, rigorously assesses this potential CVD effect in surviving rescue workers and volunteers (responders). Cohort median age is 45. We propose to complete a two-year follow-up and install a sustainable strategy for its long-term follow-up. Using the recruited and currently followed-up WTC-Heart cohort, objectives are: 1) assess the two-year coronary heart disease (CHD) and general CVD risks; 2) compare the Framingham Heart Study (FHS) scores for CHD and CVD with the observed WTC-Heart risks; extra risk factors assessed by WTC-Heart but not included in the FHS score are a) exposure to the 9/11 dust cloud and b) PTSD and depression; 3) compare the CHD risk of WTC responders aged over 55 to that of the INVEST cohort, comprised of Washington Heights, NYC residents who were not directly exposed to the air pollution and mental stress at Ground Zero; 4) install a passive follow-up procedure based on hospitalization and death registries, and determine the potential bias related from switching from an active to a passive follow-up. WTC-Heart (N=6,492) comprises responders actively recruited at annual monitoring visits at the World Trade Center Health Program (WTCHP) Mt. Sinai and North Shore sites. Determinants of cardiovascular disease, including blood lipids, 9/11 exposure, depression, and probable PTSD were measured on the date of enrollment. Measures of blood pressure, BMI, and waist circumference assessments were standardized. An on-going follow-up for incident and recurrent CVD consists of annual screenings, interviews, and medical record review. The 2-year predicted risk of CHD and the observed risk will be calculated using baseline characteristics and the results of the follow-up. Comparisons with the INVEST cohort will be done at the end of the 2-year follow-up. As of November 2013, follow-up is complete for 3,300 participants (50% of the cohort). Response rates are above 50% for the first months. Thirty-seven incident CVD events were identified through questionnaire and personal interviews. The proposed study will: 1) continue the active follow-up for another 2 years to obtain a two-year CHD and CVD risk estimates and compare them with FHS scores; and 2) install procedures for a long-term passive follow-up based on linkage with hospitalization and mortality data. In the event that the long-term cardiovascular health of 9/11 responders is impacted above and beyond the usual determinants of cardiovascular disease risk, we may propose a revised WTC-score to identify high-risk responders and guide treatment more effectively. This assessment tool will not only guide care for WTC responders, but also guide medical surveillance of civilians affected by future disasters.